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General NPI Number Information
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NPI Number | 1477708774
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Entity Type | Organization
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Legal Business Name | PLEASANT VALLEY DENTISTRY, PLLC
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Dates
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Enumeration Date | 12/01/2008
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Last Update Date | 12/01/2008
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Provider Practice Location Address
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Address Line | 9784 W YEARLING RD #1500
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City | PEORIA
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State | AZ
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Zip | 85383-1379
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Country | US
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Telephone | 623-561-1470
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Fax | 623-561-1169
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Provider Business Mailing Address
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Address Line | 9784 W YEARLING RD #1500
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City | PEORIA
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State | AZ
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Zip | 85383-1379
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Country | US
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Telephone | 623-561-1470
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Fax | 623-561-1169
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. IVAN DARIO TOVAR
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Credential | D.D.S.
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Telephone | 623-561-1470
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 5928
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License Number State | AZ
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